Hospital Visit · 99475
Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years)
What Medicare pays for 99475, what providers bill, and how the price varies across 0 states, drawn from CMS 2023 claims data.
- $435.94
- Medicare pays
- $1,880.53
- Providers bill
- 4.3×
- Markup
- #7,633 of 9,297
- Volume rank
The verdict
Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) pairs modest national service volume with a below-median markup.
- 18th pct.
- national service volume
- 30th pct.
- billed-to-Medicare markup
- 4.3×
- billed vs. Medicare
- $435.94
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Hospital Visit, the applied ratio is 1.8x Medicare (RAND 2024 Evaluation and Management bucket (1.8x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
4 more affordable than 30% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$1,880.53
What the Data Says About Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years)
Across 0 states with reporting providers, CPT code 99475 (Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years)) shows a national average Medicare payment of $435.94 against an average billed charge of $1,880.53. That gap, a 4.3x markup, or 331% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Hospital Visit procedures like this one saw 96 services billed to Medicare in 2023 by 80 distinct providers, serving 62 unique beneficiaries. Regional variation is limited in the underlying CMS file. Where state-level figures exist for initial inpatient hospital critical care of infant or young child per day (2-5 years), Geographic Practice Cost Indices (GPCIs), local malpractice premiums, and practice-expense adjustments are the usual drivers of any difference. Applying the RAND 2024 commercial-to-Medicare ratio for this category (1.8x Medicare; RAND 2024 Evaluation and Management bucket (1.8x) + CMS Medicare baseline), the estimated commercial insurance price lands near $985.49, with self-pay cash discounts commonly bringing the figure closer to $927.77. Within Hospital Visit, Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) ranks #2 of 16 tracked procedures by national average Medicare payment.
Where this sits in the registry
Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) (99475) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Hospital Visit codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) rank among Medicare procedures?
According to CMS Medicare Part B claims, Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) (CPT 99475) ranks #7,633 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #2 of 16 within Hospital Visit by national average Medicare payment. See /methodology#corpus-placement.
How much does Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) cost?
The national average Medicare payment for Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) (CPT 99475) is $435.94, while providers typically bill $1,880.53.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) cost with insurance?
With commercial insurance, initial inpatient hospital critical care of infant or young child per day (2-5 years) costs an estimated $985.49 on average (range: $689.84-$1,379.69), a moderate premium over Medicare's $435.94. Without insurance, the estimated cash price is $927.77.
How many providers perform Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years)?
Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) is comparatively uncommon: only 80 providers nationally billed Medicare for it in 2023, serving 62 beneficiaries via 96 total services.
What is the billed-to-Medicare markup for Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years)?
Providers bill 4.3x what Medicare pays for Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) - a below-median markup at 331% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($435.94 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.